MEDICARE: JARED HARGETT CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	133654	AL

General Provider Information

NPI Number	:	1316511744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED HARGETT CRNA

Provider Business Mailing Address
First Line	:	9005 HARGETT ST
Second Line	:
City	:	KIMBERLY
State	:	AL
Zip	:	35091-2410
Country	:	US
Telephone Number	:	205-641-5787
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 BLUE LAKE DRIVE, SUITE 110
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-3524
Country	:	US
Telephone Number	:	205-977-1949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2021
Last Update Date	:	05/19/2021

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